Navigating the holidays when a family member has dementia

Now that we are getting into the holiday season, many of us are planning on taking trips to visit our loved ones, or having our loved ones visit us, whether that trip is across town or across the globe. When a family member has more than mild dementia or some other type of memory loss or cognitive change, this can alter the social dynamic of holiday gatherings, particularly when families go for long times in between gatherings. Without being prepared or knowing how to respond when a family member's thinking and memory have declined, it's easy to become confused, or even upset (read: more holiday stress!) when that family member does not fill the same role they once did. Here are some Dos and Don'ts for navigating holiday gatherings that can help lower your (and everyone else's) stress when a loved one has more than mild dementia or memory loss.

DON'T call negative attention to the illness by saying things like "Don't you remember?? We just talked about that 5 minutes ago!" This type of response is both unhelpful, unproductive, and accomplishes nothing other than to belittle the person with memory loss and raise everyone else's stress level. Instead, consider one of these two options: Simply respond to the repeated question or story as if it was the first time you heard it, with the knowledge and acceptance that it might be repeated a few more times. One other option is to redirect the question or story to something else relevant.

DO talk about pleasant memories from the distant past. Most families love reminiscing about vacations they took, fiascos they endured, or other major events from the past. In people with dementia, these kinds of memories from the more distant past tend to be well-preserved, and allow the person to participate in the conversation. When the topic of conversation only includes events or developments from the more recent past, people with dementia can start to become quiet and withdrawn because they were not able to encode this recent information that would allow them to participate in the conversation.

DON'T engage in a debate or logical reasoning with a family member that has more than mild dementia. In many cases of dementia, the brain's ability (called executive functioning) to engage in this type of discussion is weakened. This means that many times, even a perfectly logical, reasonable, fair, and well-articulated argument will not be received well, if at all. Instead, consider re-directing the discussion to something different.

DO keep schedules as consistent and predictable as possible. When things become hectic, chaotic, or disorganized, symptoms of dementia tend to appear more prominently. This is because the brain's ability to problem-solve or deal with new or unexpected challenges (also called executive functions) is weakened in dementia. Even though holiday festivities are not exactly part of the everyday routine, making them more predictable by having a calendar or a schedule posted, as well as frequently talking about upcoming activities with the person with dementia can ease the degree that symptoms are exacerbated by changes in routine.

DON'T "quiz" the family member with dementia when they appear to be struggling with memory. When a family member repeats a question, avoid saying things like, "When IS Tommy getting married," or "Now what did we talk about yesterday in the car?" Though we might pose these questions out of a well-intentioned effort to "help" jog the person's memory, these types of questions are unfair to a person who has a memory disorder such as dementia. These kinds of questions assume that if the person with dementia just "thinks," or "tries harder," the effects of their disease will somehow go away, and this is seriously misguided.